Woodcock A, Lowe LA, Murray CS, et al. Early life environmental control: effect on symptoms, sensitization, and lung function at age 3 years

North West Lung Centre, Wythenshawe Hospital, Manchester M23 9LT, UK.
American Journal of Respiratory and Critical Care Medicine (Impact Factor: 13). 09/2004; 170(4):433-9. DOI: 10.1164/rccm.200401-083OC
Source: PubMed


We investigated whether environmental control during pregnancy and early life affects sensitization and lung function at the age of 3 years. High-risk children (n = 251) were prenatally randomized to stringent environmental control (active) or no intervention (control). Questionnaires, skin testing, IgE, and specific airway resistance (sRaw) measurement were completed at the age of 3 years. Children in the active group were significantly more frequently sensitized compared with control subjects (at least one allergen by skin tests: risk ratio, 1.61; 95% confidence interval [CI], 1.02-2.55; p = 0.04; mite by IgE: risk ratio, 2.85; 95% CI, 1.02-7.97; p = 0.05). However, sRaw was significantly better in the active group (kiloPascal/second, geometric mean [95% CI]: 1.05 [1.01-1.10] vs. 1.19 [1.13-1.25], p < 0.0001, active vs. control). Maximal flow at functional residual capacity was measured using rapid thoracic compression at the age of 4 weeks in a subgroup. Prospective lung function data (at infancy and 3 years) were obtained in 32 children (14 active and 18 control). There was no difference in infant lung function between the groups, but at 3 years, sRaw was significantly lower in the active compared with control children (p = 0.003). Stringent environmental control was associated with increased risk of mite sensitization but better results for some measurements of lung function in high-risk children at the age of 3 years.

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    • "Our reported adverse association between silt and wheeze would be consistent with an endotoxin mediated mechanism suggested by Braun-Fahrlander et al. (2002). Our reported association with silt provides an alternative explanation for the observation that stringent antenatal and early life dust mite eradication measures that reduce the level of house dust, whilst having minimal, if any effect on allergic sensitisation, has been reported to improve lung function (specific airway conductance) at age 3 years (Woodcock et al., 2004). Our findings raise the possibility that the beneficial effects of early life dust mite eradication may be a consequence of reductions in household silt. "
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    • "Thus, organisms exposed to immunotoxicants in utero exhibit heightened immune and inflammatory activation, often expressed as autoimmune diseases (Holladay, 1999). Children born from mothers exposed to allergens during pregnancy exhibit greater allergic responses, but also improved respiratory function (Woodcock et al., 2004). Potentiated responses to environmental stimuli could add a significant advantage in organisms for survival in the adverse environmental conditions by enabling early detection of threats, and escape from them. "
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    ABSTRACT: Adverse antenatal maternal environments during pregnancy influence fetal development that consequently increases a risk of mental health problems including psychiatric disorders in offspring. Therefore, behavioral and brain alterations caused by adverse prenatal environmental conditions are generally considered as deficits. In this article, we propose a novel hypothesis, along with summarizing a body of literatures supporting it, that fetal neurodevelopmental alterations, particularly synaptic network changes occurring in the prefrontal cortex, associated with adverse prenatal environmental conditions may be adaptation to cope with expected severe postnatal environments, and therefore, psychiatric disorders may be able to be understood as adaptive strategies against severe environmental conditions through evolution. It is hoped that the hypothesis presented in this article stimulate and open a new venue on research toward understanding of biological mechanisms and therapeutic treatments of psychiatric disorders.
    Journal of Physiology-Paris 04/2013; 107(6). DOI:10.1016/j.jphysparis.2013.04.007 · 1.90 Impact Factor
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    • "The role of allergen exposure in pregnancy and early life as a risk factor for subsequent allergic disease has been the subject of much debate. While observational studies suggest that high levels of exposure to house dust mite (HDM) allergen increase risk of allergic disease [1,2], intervention studies that reduce HDM allergen levels have failed to show any reduction in asthma or allergic disease outcomes [3-5]. Similarly, there is insufficient evidence to either recommend pet keeping, or removal, for prevention of allergic disease [6,7]. "
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